A Contemporary Analysis of Fournier Gangrene Using the National Surgical Quality Improvement Program

Kim, Stanley Y.; Dupree, James M.; Le, Brian; Kim, Dae Y.; Zhao, Lee C.; Kundu, Shilajit

doi:10.1016/j.urology.2014.08.063

Cited by 33 publications

(23 citation statements)

References 20 publications

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“…Still, the overall mortality in this cohort of 6.7% is slightly lower but comparable to other modern studies that range from 7.5-10%. [8][9][10][11] Patients who died in this study tended to do so later in their illness course. Only one patient died during the first two days of admission, suggesting mortality was mostly due to delayed consequences of the disease rather than acute overwhelming infection.…”

Section: Discussionmentioning

confidence: 73%

“…[5][6][7] However, likely due to improved processes of care for these patients, modern series suggest significantly lower mortality rates of 10% or less. [8][9][10][11] Although mortality has dropped dramatically, these patients remain impacted by disease morbidity, including multi-organ system dysfunction, prolonged hospitalization, complex wound care and ongoing care needs beyond hospital discharge. [12][13][14] Owing to the high acuity and required multidisciplinary care of these patients, transfer to a tertiary care center is often necessary.…”

Section: Introductionmentioning

confidence: 99%

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Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Osbun

Hampson

Holt

et al. 2017

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Osbun

Hampson

Holt

et al. 2017

Journal of the American College of Surgeons

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“…[2][3][4] Kim et al reviewing 650 Fournier's patients obtained from a large national database (the National Surgical Quality Improvement Program database) found the mortality rate to be 10.1% and suggested that this represented a more accurate description of contemporary mortality rates from the disease. 4 The mortality rate of 15% (3/20) in this series falls within the range of mortality rates reported in the literature and is closer to the more contemporary rate published by Kim et al All three patients who died in our cohort were transferred from other healthcare facilities, suggesting possible pre-existing deconditioning on admission. Two of the three patients had received treatment with NPWT, while none was treated with HBOT or tangential hydrosurgery.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are comparable to the contemporary Fournier's gangrene mortality rate of 4.7-10.1%. [2][3][4] Every 1-point increase in FGSIS conferred a 32% increased chance of prolonged hospital stay (>25 days) and risk of mortality.…”

Section: Key Findingsmentioning

confidence: 99%

“…1 The disease has historically been associated with a high rate of morbidity and mortality; however, modern mortality rates have been reported ranging from 4.7% to 10.1%. [2][3][4] As described by Fournier in 1883, the typical patient was a young healthy male who developed an idiopathic, fulminant, necrotizing fasciitis of the male genitalia. 2 Since its first description, this classic picture of the Fournier's gangrene patient has changed.…”

Section: Introductionmentioning

confidence: 97%

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Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016

Ferretti

Saji

Phillips

2017

Advances in Wound Care

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Objective: The outcome of Fournier's gangrene (FG) may be affected by comorbidities, demographics, and choice of treatment modality. We sought to evaluate our institution's management protocol of FG measured by mortality rate (MR) and length of hospital stay (LHS) in a retrospective cohort study. Approach: A database of 20 FG cases at our institution throughout the 2009-2016 study period was assembled by a retrospective review of medical records. A Fournier's Gangrene Severity Index Score (FGSIS) was calculated for each case. Data were analyzed for statistical significance using logistic regression. Results: The most common presentation of FG at our institution was a hyperglycemic diabetic male in his fifth decade of life with a second risk factor such as recent surgery or active malignancy. The average FGSIS was 9 overall and 14 for the mortalities. An increased FGSIS was predictive of having an increased MR or hospital stay above the median (>25 days) ( p = 0.0194). The average LHS was 32 days overall, 22 days for patients treated with hyperbaric oxygen therapy and 40 days for patients treated with tangential hydrosurgery. Overall MR was 15%. Innovation: This is the second known study to characterize usage of tangential hydrosurgery in the management of FG. Conclusion: Treatment outcomes at our institution are comparable to those reported in recent literature, a significant decline from the historical MR of 50-60%.

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Association of Sodium-Glucose Cotransporter 2 Inhibitor Treatment With Risk of Hospitalization for Fournier Gangrene Among Men

Schneeweiß

Patorno

2019

JAMA Intern Med

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lars, will need to be covered somewhere. Without additional large financial authorizations, these costs will likely result in resource reductions from within the VA, leading to a diminution of capabilities for the system. This would be a bad outcome and ironically may lead to less choice for veterans.The purpose of a health care system should be to match its capabilities with the clinical needs of the patients it serves. To achieve this, the VA must transition from simply being a provider of care to a network coordinator of care. Although opening the aperture to private care, the VA's proposed access standards based on nonclinical criteria will not serve veterans' interests. We should not be using arbitrary administrative rules, such as drive times and wait times (that are not based on clinical evaluations), when it comes to people's health care.The system should be based on the individual clinical needs of the veteran. Veterans and their physicians (or other licensed heath care professionals), not government policy makers, must decide when and where the most appropriate care can and should be delivered.What is needed is a clinically integrated system that uses the best of the VA and the private sector. 6 This integration can be achieved through building a system of care that offers clinically based decisions with coordinated care between the VA and private sector, transparency of outcomes, and competition based on quality and service. In addition, better predictive analytics for medical management, as well as enhanced efforts to empower veterans with better information about their own care plans, will be essential to improving the safety of the system.The VA's efforts to reform are necessary and good. Greater choice for veterans is also good. However, without the appropriate clinical safeguards, as this study by Thorpe and colleagues 2 demonstrates, unintended consequences are possible. It is essential that access standards be based on sound health policy. Our veterans deserve no less.

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A Contemporary Analysis of Fournier Gangrene Using the National Surgical Quality Improvement Program

Cited by 33 publications

References 20 publications

Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Low-Volume vs High-Volume Centers and Management of Fournier's Gangrene in Washington State

Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016

Association of Sodium-Glucose Cotransporter 2 Inhibitor Treatment With Risk of Hospitalization for Fournier Gangrene Among Men

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